Provider Demographics
NPI:1831519099
Name:TEMPLE, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8186 COUNTY ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ANGELICA
Mailing Address - State:NY
Mailing Address - Zip Code:14709-8645
Mailing Address - Country:US
Mailing Address - Phone:585-808-4072
Mailing Address - Fax:
Practice Address - Street 1:8186 COUNTY ROAD 16
Practice Address - Street 2:
Practice Address - City:ANGELICA
Practice Address - State:NY
Practice Address - Zip Code:14709-8645
Practice Address - Country:US
Practice Address - Phone:585-808-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006007-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health